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Mehul Patel; A Review of Orbital Fractures at a Level 1 Trauma Center - Do all visually asymptomatic patients require emergent ophthalmological evaluation?. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3047.
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© ARVO (1962-2015); The Authors (2016-present)
The evaluation and management of orbital fractures, which are common ophthalmologic reasons for ER visits, varies widely across hospitals. We performed a retrospective, observational clinical study at a Level 1 Trauma Center where all CT diagnosed orbital fractures are evaluated within six hours of presentation to identify signs and symptoms that are likely to be indicative of vision threatening ocular injury. We hypothesize that patients without visual symptoms are likely to not have vision threatening injuries and can be triaged appropriately.
We performed a retrospective chart review of 109 diagnosed patients with orbital fractures from 6/2012 to 6/2014. We extracted baseline information from each evaluation, including Age, Mechanism, Visual Acuity (VA), Intraocular Pressure, Pupillary Exam, Symptoms, Severe Injuries (Globe Rupture, Retinal Tear, Vit Heme, Hyphema, Entrapment, Traumatic Optic Neuropathy, Orbital Cellulitis, Conj Laceration and Retrobulbar Hemorrhage), Moderate Injuries (Choroidal Rupture, Iritis, Microhyphema, Corneal Abrasion, Eyelid Lac), & Mild injuries (Subconj Heme, Periorbital Contusion, Retinal Hemorrhage, Commotio/Berlin’s Edema, Traumatic Mydriasis and V2 Hypoesthesia.)Inclusion criteria included CT diagnosis of new fracture and age >= 18 years of age. Microsoft Excel software was used for data analysis.93 (85%) were male, (p<0.001.) Age range was 18-82; average was 40.2±15.2 years.
81 (74%) fractures were due to assault, 15 (14%) were fall related and the rest were due to other causes. Most common symptoms included Pain (70%), Blurry Vision (29%), Headache (14%), Photophobia (5%) & Diplopia (5%).23 of patients presented with at least one major and/or moderate finding on exam and VA ranged from (20/20-LP). One required urgent surgery. 79 (73%) presented without a major or moderate finding on exam and these patients had VA ranging from (20/20-HM), of which 75 (95%) had VA of 20/100 or better. None required urgent surgery.Visual Symptoms were found more often (65% vs. 30%) of moderate and major findings vs. minor or no exam findings. (p<0.001)
Patients who present with orbital trauma and CT diagnosed orbital fractures but are without visual symptoms may be triaged accordingly by emergency room providers given normal baseline exam of visual acuity, intraocular pressure and pupillary exam.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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